Highly regulated industries like financial services and insurance are accountable to various state agencies and departments. In the insurance industry, State Department of Insurance offices require that an insurance company track and manage complaints related to the services and products the insurance company offers. Some examples of these complaints include: improper denial or delay in settlement of a claim; non-receipt of documents such as policies; alleged illegal cancellation or termination of an insurance policy; alleged misrepresentation by an agent, broker, or solicitor; alleged theft of premiums paid to an agent, broker, or solicitor and other problems concerning insurance premiums, renewals and rates, etc. An insurance company might receive many thousands and even millions of complaints in a single year. These complaints may be received in a variety of ways and formats such as via a local Department of Insurance, through agents' systems, or directly via postal mail, facsimile machines, and email. Moreover, the insurance company will typically receive many different types of documents and supporting materials such as bills, accident reports, policies, renewal cards and claim forms and those documents will be received from various types of parties e.g., claimants, agents, and other insurance companies.
For each complaint filed, the insurance company needs to track and manage the complaint from complaint initiation to final resolution. Generally, the complaint will need to be validated with an appropriate insurance policy. Moreover, various documents associated with the complaint may need to be collected together in order to be processed in an orderly fashion. Such actions can be time consuming, error prone, and difficult to administer on a cost effective basis, especially when a substantial numbers of documents and insurance claim complaints are involved. Finally, the resolution progress and outcome of each and every complaint needs to be tracked and reported. These requirements place a large administrative and financial burden on the insurance companies.